Grace Argentino Kristen Argo

1. Madeleine Leininger • The Cultural Component Grace Argentino Kristen Argo

2. Madeleine M. Leininger "...first nurse anthropologist and founded the discipline of transcultural nursing, the ethnonursing qualitative research methodology, the Council on Nursing and Anthropology with the American Anthropological Association/Society for Applied Anthropology, the Transcultural Nursing Society, and the Journal of Transcultural Nursing" (Ray, 2013, p.143). 1925-2012

3. Madeleine M. Leininger Origins of Nursing Model After an extensive three year study in New Guinea, Leininger realized there was an association between culture and health care. The healthcare industry was not prepared to effectively meet the cultural needs of individuals and their families due to a lack of knowledge and understanding of cultural values. This became the motivating factor in her quest to establish the discipline of transcultural nursing.

4. Madeleine M. Leininger Origins of Nursing Model Her studies led to the development of the Theory of Culture Care Diversity and Universality, laying the foundation for the transcultural nursing movement. Her goal was to provide the necessary tools to provide culturally congruent care that integrated the patient's cultural beliefs and values to produce results that were both effective and satisfying to the patient.

5. Leininger's Theory Information and Concepts "There are certain basic concepts, or ideas, that are essential to an understanding of professional nursing practice; they are the building blocks of nursing. These concepts are person, environment and health. Everything professional nurses do is in some way related to one of these basic inter-related concepts..." (Chitty & Black, 2011, p. 272). Madeleine Leininger's culture care theory encompasses all four global concepts while emphasizing the need to incorporate the patient's cultural beliefs into their care.

6. Theory of Culture Care Diversity and Universality "...states that care is the essence of nursing and the dominant, distinctive, and unifying feature of nursing. Human caring varies among cultures in its expression, processes, and patterns" (Potter & Perry, 2009, p.50).

7. Leininger's Sunrise Model "...demonstrates the inclusiveness of culture in everyday life and helps to explain why cultural assessment needs to be comprehensive...assumes that cultural care values, beliefs, and practices are fixed in the cultural and social structural dimensions of society, which include environmental context, language, and ethnohistory" (Potter & Perry, 2009, p.113).

8. Sunrise Enabler

9. The Four Global Concepts Health Leininger's theory defines health as a "state of well-being that is culturally defined, valued, and practiced, and which reflects the ability of individuals (or groups) to perform their daily role activities in culturally expressed, beneficial, and patterned lifeways" (Taber's Cyclopedic Medical Encyclopedia, 2013).

10. The Four Global Concepts Person Chitty and Black (2011) infers that people are "systems with human needs" (p. 274). Leininger's theory delves into the realm of each person's human needs based on their cultural beliefs.

11. The Four Global Concepts Person Ethnohistory is defined as "past facts, events, instances, experiences of individuals, groups, cultures, and institutions that are primarily people centered (ethno) and which describe, explain, and interpret human lifeways within particular cultural contexts and over short or long periods of time"(Taber's Cyclopedic Medical Encyclopedia, 2013). Leininger's cultural care theory recognizes the importance of ethnohistory and how it helps define a person and their needs.

12. The Four Global Concepts Environment The environmental concept of Leininger's theory is "the totality of an event, situation, or particular experiences that give meaning to human expressions, interpretations, and social interactions in particular physical, ecological, sociopolitical, and/or cultural settings" (Taber's Cyclopedic Medical Encyclopedia, 2013).

13. The Four Global Concepts Nursing The goals of nursing practice developed by Madeleine Leininger are "to improve and to provide culturally congruent care to people that is beneficial, will fit with, and be useful to the client, family, or culture group healthy lifeways; to provide culturally congruent nursing care in order to improve or offer a different kind of nursing care service to people of diverse or similar cultures". (Taber's Cyclopedic Medical Encyclopedia, 2013)

14. The Four Global Concepts Nursing Madeleine Leininger states "Clients who experience nursing care that fails to be reasonably congruent with their beliefs, values, and caring lifeways will show signs of cultural conflicts, noncompliance, stresses, and ethical or moral concerns" (Clarke, McFarland, Andrews & Leininger, 2009, p. 235).

15. Relationship of Concepts Every human being is a unique individual with different needs and characteristics. Their environments, views on health and health care and beliefs all differ. The four global concepts necessary for effective patient care are not stand alone ideals. They interact with each other and constantly change the balance regarding a person's wellness. The concept of culturally congruent nursing combines the four concepts with an emphasis on cultural understanding to promote the health and well-being of the patient.

16. Madeleine M. Leininger Interpretation and Inferences/Implications and Consequences As stated by the philosophy and values of Transcultural Nursing (TCN) "Human care/caring is defined within the context of culture. Culturally competent care can only occur when culture care values are known and serve as the foundation for meaningful care" (Transcultural Nursing Society, 2013).

17. Madeleine M. Leininger Interpretation and Inferences/Implications and Consequences Nurses must critically reflect on their own values and beliefs, and determine the impact it has on providing culturally congruent care. Gaining knowledge of different cultural beliefs and values will enable nurses and other healthcare providers to plan appropriate care, beneficial to the patient's health and well-being.

18. Madeleine M. Leininger Interpretation and Inferences/Implications and Consequences A set of 12 universal standards for providing cultural nursing care were developed by members of the Transcultural Nursing Society and the Expert Panel for Global Nursing and Health of the American Academy of Nursing. They can be found through the following link listed below in Table 1, on page 258. http://www.tcns.org/files/StandardsofPracticeforCulturallyCompetentNursingCarearticle.pdf

19. Madeleine M. Leininger Interpretation and Inferences/Implications and Consequences Without Leininger's influence in the development of transcultural nursing, individuals, families, groups, and institutions might not have their needs met due to the lack of understanding of how cultural differences influences health and health patterns. Misunderstandings may be conveyed as insults, rude behavior, or a sign of disrespect. A lack of understanding may cause reluctance in an individual's choice to return for future care.

20. Evaluation of Transcultural Nursing Origin There are many nursing theories regarding patient care and well-being which have similar or overlapping concepts. Madeleine Leininger's theory is unique as it is "the only nursing theory focused explicitly on culture care as the dominant domain of nursing inquiry. The theory is a holistic, culturally based care theory that incorporates broad humanistic dimensions about people in their cultural life context" (Leininger, 2007, p. 9).

21. Evaluation of Transcultural Nursing Origin "It is also unique in its incorporation of social structure factors, such as religion, politics, economics, cultural history, lifespan values, kinship, and philosophy of living; and geo-environmental factors, as potential influences of culture care phenomena" (Leininger, 2007, p. 9).

22. Evaluation of Transcultural Nursing Origin "Another unique feature of the culture care theory was the focus on emic and etic care knowledge. Emic knowledge comes directly from cultural informants as they know and practice care with their values and beliefs in their unique cultural contexts. Emic knowledge was the natural, local, indigenous root care values. In contrast, etic care knowledge was derived from outsider views of non-local or non-indigenous care values and beliefs such as those of professional nurses"(Leininger, 2007, p.10).

23. Evaluation of Transcultural Nursing Content Madeleine Leininger's theory of transcultural nursing falls into the description of the four global concepts as every aspect is incorporated into the care of the patient. While the theory itself is broad, it can be utilized in any area in the health field. Society continues to become more and more diverse and people in every culture need health care at some point in their lives.

24. Evaluation of Transcultural Nursing While other theories have not been generated from this model, there has been a significant increase in transcultural nursing over the decades.

25. Evaluation of Transcultural Nursing "Culturally congruent care has become a sought-after goal today and a mantra for many health organizations and professions, nationally and transnationally...in many states and countries, it has become a goal and an expected norm of healthcare services" (Leininger, 2007, p. 9).

26. Theory in Practice The practice of transcultural nursing has increased globally since Madeleine Leininger first presented it decades ago. Today's communities are becoming more ethnically diverse and the need to understand the beliefs and values among the different cultures is becoming more important. Once an understanding and acceptance exist, caregivers can begin to provide culturally congruent care that is more effective for their patients.

27. Theory in Practice "Nurses who work in other countries, particularly developing nations, face two significant moral concerns: how to interface with established cultural norms and how to handle the novel ethical dilemmas that arise from practicing in a different culture. The standard ways of making decisions, used in one’s own culture, are challenged and often require greater cultural sensitivity and ethical reflection" (Crigger & Holcomb, 2007, p. 70).

28. Theory in Practice "Before the authors engaged in health care efforts in Honduras, they considered how to approach a culture in which they had little knowledge...Four ways of thinking about service and the people served were formed. They are revealing ignorance, reverencing the culture, refraining from harm, and reducing biomedical and cultural ethnocentricity" (Crigger & Holcomb, 2007, p. 72-73). Revealing ignorance pertains to the fact that anyone outside of a culture may learn how to work with, communicate with and treat people from said culture, but they will never be “of” that culture.

29. Theory in Practice "...after more than 10 years of involvement in Honduras, the authors have limited understanding of the culture. But they realize that the Honduran culture makes perfect sense to the Honduran people they encounter. The authors accept the fact that they are in a dynamic process of piecing together an understanding of the culture and who these people truly are. With their work in Honduras, each exposure to the culture brings them closer to understanding" (Crigger & Holcomb, 2007, p. 74).

30. Theory in Practice "Failure to acknowledge and work with the existing culture and its health care system is identified as a barrier to work in other cultures. Many of the major public health issues encountered in Honduras were beyond the abilities of the authors to change. Although health care providers can encourage changes and educate the people with whom they work, they do not have the ability to implement the sweeping social changes needed to address significant public health issues. The authors had to accept the public health limitations in the country and at the same time respect the culture for the services that were provided" (Crigger & Holcomb, 2007, p. 73).

31. Theory in Practice "Cultures can adopt external ideas too quickly, and it can be harmful. On the other hand, cultures may resist adopting and be harmed by not adopting a view quickly enough" (Crigger & Holcomb, 2007, p. 74). Nurses must be able to blend cultural ideals whether the patient has come to them in a hospital setting foreign to them or if the nurse has chosen to practice in a country with different cultural backgrounds than they are used to.

32. Theory in Practice Standards for culturally competent nursing care can be found in The Journal of Transcultural Nursing at the following link: http://0-tcn.sagepub.com.libcat.ferris.edu/content/22/4/317

33. Madeleine M. Leininger Conclusion Madeleine Leininger's theory of culture care diversity and universality was a groundbreaking step in nursing care. Transcultural nursing is a vital component in nursing care worldwide due to the increase in immigration and the vast differences in every culture. "The nursing outcome of culturally congruent care is health and well-being for the patient" (Chitty & Black, 2011, pg. 316) which is what we should all be striving for as professional nurses.

34. Case Study "A 70-year-old Hmong mother and her 45-year-old son came to a large hospital to get help with “mother’s pains.” The son was culturally obligated to remain with his mother at all times. The mother did not speak English and relied on her son for everything. The mother had several cultural amulets she wore on her neck and wrist for spiritual protection. The staff nurse quickly removed the amulets as “they were dirty strings.” The mother cried immediately and pleaded to her son to return these objects to her for protection. She refused medications and was viewed by the staff nurses as “uncooperative and resistant'"(Leininger, 2003, p. 157). What would you have done differently if you were the nurse caring for this patient?

35. Case Study The nurse is caring for a Middle Eastern postpartum patient who gave birth to a son the day prior. The woman barely speaks English, and is surrounded by her mother-in-law and sister. The new mother is sleeping and the mother-in-law is changing the baby. Upon entering the room, you are told "she rest" by the grandmother. How would you plan interventions that are culturally sensitive to the Middle Eastern culture, understanding it is customary in the patient's culture for the mother-in-law to take over care of the infant during the first few months of life?

36. References Chitty, K., & Black, B. (2011). Professional nursing: Concepts & challenges (6th ed.). Maryland Heights, MO: Saunders Elsevier Clarke, P., McFarland, M., Andrews, M., and Leininger, M. (2009). Caring: Some reflections on the impact of the culture care theory by McFarland & Andrews and a conversation with Leininger. Nursing Science Quarterly, 22, 233-239. doi: 10.1177/0894318409337020 Crigger, N., and Holcomb, L. (2007). Practical strategies for providing culturally sensitive, ethical care in developing nations. Journal of Transcultural Nursing, 18, 70-76. doi: 10.1177/1043659606294198 Douglas, M. K., Uhl Pierce, J., Rosenkoetter, M., Callister, L. C., Hattar-Pollara, M., Lauderdale, J., ...Pacquiao, D. (2009) Standards of practice for culturally competent nursing care: A request for comments. Journal of Transcultural Nursing, 20 (3), 257-269. doi: 10.1177/1043659609334678

37. References Leininger, M. (2007). Theoretical questions and concerns: Response from the theory of culture care diversity and universality perspective. Nursing Science Quarterly, 20, 9-13. doi: 0.1177/08943184062967841 Leininger, M. (2003). Founder's focus: Transcultural nursing makes a big outcome difference. Journal of Transcultural Nursing, 14, 157. doi: 10.1177/1043659602250650 Madeleine Leininger. (2013). In Taber's Cyclopedic Medical Dictionary online. Retrieved from http://0-online.statref.com.libcat.ferris.edu Potter, P. A., & Perry, A. G. (2009). Fundamentals of nursing (7th ed.). St. Louis, Missouri: Mosby Elsevier.

38. References Ray, M. A., (2013). Madeleine M. Leininger 1925-2012. Qualitative Health Research, 23 (1), 142-144. doi:10.1177/10497323 12464578 Transcultural Nursing Society. (2013). Philosophy/values. Retrieved from http://www.tcns.org/